Intrahepatic Cholangiocarcinomas Have Histologically and Immunophenotypically Distinct Small and Large Duct Patterns

The American Journal of Surgical Pathology
Carlie S SigelDavid S Klimstra

Abstract

Intrahepatic cholangiocarcinomas are histologically heterogenous. Using a cohort of 184 clinically defined, resected intrahepatic cholangiocarcinomas, we retrospectively classified the histology into 4 subtypes: large duct (LD), small duct (SD) (predominantly tubular [SD1] or predominantly anastomosing/cholangiolar, [SD2]), or indeterminate. Then, we tested the 4 subtypes for associations with risk factors, patient outcomes, histology, and immunophenotypic characteristics. SD was the most common (84%; 24% SD1 and 60% SD2) with lower proportions of LD (8%), and indeterminate (8%). Primary sclerosing cholangitis was rare (2%), but correlated with LD (P=0.005). Chronic hepatitis, frequent alcohol use, smoking, and steatosis had no histologic association. LD was associated with mucin production (P<0.001), perineural invasion (P=0.002), CA19-9 staining (P<0.001), CK7, CK19, CD56 immunophenotype (P=0.005), and negative albumin RNA in situ hybridization (P<0.001). SD was histologically nodular (P=0.019), sclerotic (P<0.001), hepatoid (P=0.042), and infiltrative at the interface with hepatocytes (P<0.001). Albumin was positive in 71% of SD and 18% of LD (P=0.0021). Most albumin positive tumors (85%) lacked extracellular mucin (P<0.001)...Continue Reading

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Citations

Aug 20, 2019·Journal of Clinical Pathology·Diane G BrackettVikram Deshpande
Dec 27, 2019·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Sylvie JobJamila Faivre
Aug 3, 2019·Japanese Journal of Radiology·Mami HamaokaSatoshi Kobayashi
Apr 17, 2020·Virchows Archiv : an International Journal of Pathology·Kwun Wah WenWon-Tak Choi
Nov 20, 2020·Applied Immunohistochemistry & Molecular Morphology : AIMM·Katrina CollinsSaverio Ligato

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